How do we best inform higher risk women of their breast cancer (BC) risk to assist them in making informed decisions about tamoxifen (Tam) for BC chemoprevention? To address this question, methods that use biomarkers, such as atypia, to risk-stratify high- risk patients and more precisely define individual risk is very promising. To this end, Random Periareolar Fine Needle Aspiration (RPFNA) shows much promise as a research tool predicting individual BC risk. For processes of informed decisions, women must have an understanding of what the RPFNA result means and how it applies to the reevaluation of perceptions of BC in light of other risk factors, and subsequent decisions about using Tam. Two factors that may be critical to affecting the above processes are patients' levels of health literacy and numeracy. Based on this rationale, the proposed study will be the first to address: 1) how patients factually understand and derive affective (i.e, emotional) meaning from the RPFNA result; 2) and how such understandings affect perceptions of BC risks and worry, and subsequent decision-making processes involving Tam; and 3) how numeracy and health literacy affect understanding, and as a result, perceptions of BC risk, and decision- making processes involving Tam. To address these goals, about 120 women attending the Prevention Clinic at Duke University Medical Center who elect to have RPFNA and have a five-year BC risk of > 1.66% will complete a baseline survey that assesses: (1) perceptions of BC risk and worry, (2) knowledge of and perceptions of Tam's risks and benefits and interest in its use as well as numeracy and health literacy. Women will then undergo RPFNA and return for a second clinic visit to discuss the result. Following the consultation, we will assess understanding of the result and reassess perceptions of BC risk and worry, Tam's risk and benefits and decision to use. Study results are relevant for understanding how RPFNA and biomarkers more generally can be integrated into clinical practice effectively to affect perceptions of BC risk and decision making about BC prevention strategies. This will be the first study to explore in actual clinical practice how the inter- relationships between breast cancer risk perceptions, Random Periareolar Fine Needle Aspiration (RPFNA) results, and Tamoxifen are understood to affect decisions about breast cancer prevention; this study is at the very forefront of learning about the possible strengths and weaknesses of using RPFNA as a model of communicating biomarkers in clinical practice that may generalize to the use of other methods of providing biomarker information. Findings can contribute to future interventions to improve the effective communication and understanding of breast cancer risk using biomarkers and decisions involving the clinical management of care among women at higher breast cancer risk. [unreadable] [unreadable] [unreadable]